Perioperative Antidepressant Use is Associated With Symptomatic Pseudarthrosis After Lumbar Fusion.

Study design: Retrospective cohort.

Objective: To explore the relationship between symptomatic pseudoarthrosis requiring revision after lumbar fusion and antidepressant use.

Summary of background data: Approximately 25% of patients undergoing spine surgery are taking antidepressants. Pseudoarthrosis is a significant complication of spinal fusion surgery that can lead to debilitating pain and revision surgery. Animal models have identified selective serotonin reuptake inhibitors/serotonin and norepinephrine reuptake inhibitors (SSRIs/SNRIs) as detrimental to bone healing, and one database study identified antidepressants as associated with lumbar pseudoarthrosis. However, no single institution study has replicated these findings.

Materials and methods: A structured query language search identified patients from 2017 to 2022 with pseudoarthrosis after lumbar fusion-this was verified by pseudoarthrosis and listed as the indication for revision surgery in operative notes and by reviewing preoperative computed tomography imaging. Patients were counted as taking antidepressants if an antidepressant was an active medication at their preoperative and first postoperative appointments. Control patients who had no radiographic indication of pseudoarthrosis at their last clinical follow-up were matched 3:1 with pseudoarthrosis patients requiring revision based on smoking status, levels fused, levels decompressed, and procedure type. Statistical analysis was performed to compare the two groups.

Results: Thirty-six patients were identified that had revision for symptomatic pseudoarthrosis after primary, elective lumbar fusion. These patients were compared with 108 patients who had lumbar fusion without pseudoarthrosis. Patients with pseudoarthrosis had higher rates of diagnosed depression ( P =0.019), anxiety ( P =0.007), and antidepressant use ( P =0.001). Logistic regression identified SSRI/SNRI use as an independent predictor of requiring revision surgery for symptomatic lumbar pseudoarthrosis (OR=3.95, CI=1.66-9.45, P =0.002).

Conclusions: Patients requiring revision surgery for lumbar pseudoarthrosis had a higher rate of depression, anxiety, and antidepressant use. SSRI/SNRI use was identified as an independent predictor of requiring revision surgery for lumbar pseudoarthrosis. Future, prospective studies are needed to further evaluate this association.

Level of evidence: Level III.